内镜下食管扩张并置入金属支架治疗食管下段癌2例

1　病历摘要例 1:患者男 ,藏族 ,5 1岁。因反复上腹部疼痛10余年 ,伴吞咽困难 ,消瘦半个月收住院。胃镜检查距门齿 4 0cm处可见新生物 ,向管腔内隆起 ,表面呈现结节状 ,质地软 ,易出血 ,因管腔狭小 ,无法进镜。诊为食管下段癌。例 2 :患者男 ,藏族 ,5 4岁。因间断上腹部疼痛伴吞咽困难 4个月入院。行胃镜检查距门齿 38cm处可见新生物 ,呈现菜花样变 ,周边欠规整 ,向腔内隆起 ,易出血 ,管腔狭窄 ,无法进镜 ,诊为食管下段癌。2　方法术前准备与常规胃镜检查相同 ,另肌注杜冷丁5 0mg ,将胃镜插至狭窄部位 ,通过活检孔将导丝送入并穿过狭窄部到…     

循环式扩张治疗食管化学灼伤后狭窄20例

目的　探讨食管化学灼伤后狭窄的简单、有效治疗方法 .方法　胃造瘘术后 ,食管内置入丝线 ,从鼻腔和胃造瘘口拉出连结 .用自制的食管扩张器 ,在丝线引导下进行扩张 .结果　食管上段狭窄 4例 ,中段 4例 ,下段 2例 ,全程不规则线状狭窄 1 0例 .经 3～ 8m o间断扩张治疗 ,全部顺利通过 1 8mm扩张器 ,进普食顺利 .经 2～ 5 a随访 ,效果良好 .结论　食管化学灼伤后狭窄行循环式扩张治疗是一种简单、有效、安全、经济的好方法 ,值得推广应用     

Surgical risk for patients with Chagasic achalasia and its correlation with the degree of esophageal dilation

AIM: To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation, thereby proposing a risk scale index. METHODS: One hundred and twenty-four patients with Chagasic esophageal achalasia, who received surgical treatment at the Hospital das Clinicas of the Federal University of Goias, were included in this study. The patients were mostly related to the postoperative complications due to the cardiovascular system. All the patients were submitted to: (1) clinical history to define the cardiac functional class (New York Heart Association); (2) conventional 12-lead electrocardiogram at rest; and (3) contrast imaging of the esophagus to determine esophageal dilatation according to Rezende's classification of Chagasic megaesophagus. RESULTS: An assessment of the functional classification (FC) of heart failure during the preoperative period determined that 67 patients (54.03%) were assigned functional class I (FC I), 46 patients (37.09%) were assigned functional class II (FC II), and 11 patients (8.87%) were assigned functional class III (FC III). None of the patients were assigned to functional class IV (FC IV). There was a positive correlation between the functional class and the postoperative complications (FC IXFC II: P<0.001; FC IXFC III: P<0.001). The ECG was normal in 44 patients (35.48%) and presented abnormalities in 80 patients (64.52%). There was a significant statistical correlation between abnormal ECG (arrhythmias and primary change in ventricular repolarization) and postoperative complications (P<0.001). With regard to the classification of the Chagasic esophageal achalasia, the following distribution was observed: group II, 53 patients (42.74%); group III, 37 patients (29.83%); and group IV, 34 patients (27.41%). There was a positive correlation between the degree of esophageal dilation and the increase in postoperative complications (grade IIXgrade III achalasia: P<0.001; grade IIXgrade IV achalasia: P<0.001; and grade IIIXgrade IV achalasia: P = 0.017). Analyzing these results and using a multivariate regression analysis associated with the probability decision analysis, a risk scale was proposed as follows: up to 21 points (mild risk); from 22 to 34 points (moderate risk); and more than 34 points (high risk). The scale had 82.4% accuracy for mild risk patients and up to 94.6% for the high risk cases. CONCLUSION: The preoperative evaluation of the cardiovascular system, through a careful anamnesis, an ECG and contrast imaging of the esophagus, makes possible to estimate the surgical risks for Chagas' disease patients who have to undergo surgical treatment for esophageal achalasia.     

放疗联合食管扩张治疗食管癌10例

我们2001年4月至2003年4月，对10例诊断为食管癌放疗后致食管狭窄的病人行食管扩张治疗，术后进食梗阻缓解，取得了较好的效果。     

长效多功能胃造口术的临床应用

部分食管良、恶性狭窄的患者进行术前准备或作为辅助治疗措施时会采用胃造口术。胃造口的目的在于胃引流减压、胃饲养或终身胃肠改道。对于治疗食管瘢痕狭窄进行拉线循环扩张者,需要多功能且保留时间较长．但又非永久性胃造口。若按传统术式进行,往往遭致失败．诸如胃管脱出无法再插入,     

食管扩张术联合吞咽训练治疗术后食管吻合口狭窄的疗效观察

目的观察食管扩张术联合吞咽训练治疗食管癌、贲门癌术后食管吻合口狭窄的疗效及对患者生活质量的影响。 方法将135例术后食管吻合口狭窄患者随机分为治疗组及对照组。2组患者均于胃镜指导下应用萨氏扩张器进行食管扩张手术治疗,治疗组在此基础上辅以吞咽训练,每天训练2组吞咽活动,每组10～20次。于治疗前及治疗2、4、8周时检查并记录2组患者进食及吻合口直径变化情况,同时采用SF-36量表对2组患者生活质量进行评定。 结果2组患者治疗后其进食功能均有不同程度改善,其中Ⅰ级狭窄患者吻合口直径组间差异无统计学意义（P&rt;0.05）;Ⅱ级狭窄及Ⅲ级狭窄患者吻合口直径组间差异均有统计学意义（P<0.05）,并以治疗组的改善幅度及疗效持续时间较显著;对2组Ⅱ级及Ⅲ级狭窄患者SF-36量表评分结果比较后发现,治疗后2组患者生活质量均有一定程度改善（P<0.05）,且以治疗组的改善幅度较显著,与对照组比较,组间差异具有统计学意义（P<0.01）。 结论食管狭窄扩张术联合吞咽训练能进一步巩固扩张疗效,延缓吻合口发生再狭窄时间,从而改善患者进食功能,促使生活质量提高,并且该联合疗法具有安全、有效、操作简单等特点,值得临床推广应用。      

独特临床经过的迷走右锁骨下动脉一例

患者男,73岁。因吞咽困难伴呕吐、呛咳6 d入院。6 d前患者进固体食物时出现梗咽感,随后进流质食物也出现梗咽感,伴呕吐、呛咳和窒息感。间断发作,发作次数逐渐增多,进食量骤减,并出现声音嘶哑、咳嗽、咳少量白色粘液痰。呕吐物中无胃肠液和宿食。既往有Ⅱ型糖尿病和高血压病史20年,左输尿管结石病史5年。吸烟指数550年支。入院查体:     

清热化瘀方改善食道支架置入术后不适症状临床观察

食道良、恶性狭窄均使患者吞咽困难,甚者滴水不进,随着内镜治疗技术发展,经食管扩张,施放食管支架,可提高患者的生存质量,但术后一周内患者胸痛、胸骨后异物感等不适症状严重,应用中药清热化瘀方可明显减轻患者不适症状,现将本院2001年3月至今治疗本病42例患者的情况报道如下。     

Wallstent和Gianturco-Z stent治疗上消化道狭窄的体会

现在流行应用的食管扩张支架在设计、材料和释放的方法上有所不同[1] 。作者应用国产Ｗａｌｌｓｔｅｎｔ(简称Ｗ )和Ｇｉａｎｔｕｒｃｏ -Ｚｓｔｅｎｔ(简称Ｚ)分别治疗上消化道狭窄 ,并就两种支架的物理性能与疗效及并发症之间的关系作一探讨。1　资料与方法1·1　资料　男 32例 ,女 16例 ,年龄 36～ 84岁。全部病例的狭窄段均位于距门齿 19ｃｍ以下 ,其狭窄类型及狭窄程度的分级[2 ] ,见表 1。所用支架直径均为18ｍｍ ,长度为狭窄长度 (ｃｍ) + 4～ 6ｃｍ。表 1　Ｗ和Ｚ支架置入前的狭窄类型和狭窄程度 (例 )分组例数狭窄类型术后吻合术肿…